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Systematic review and network meta-analysis of cryptoglandular complex anal fistula treatment: evaluation of surgical

Isabel Sierra Fernández1, Zutoia Balciscueta Coltell2, Natalia Uribe Quintana2

  • 1Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, Valencia, Spain. isa.sierra92@gmail.com.

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|May 29, 2025
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Summary
This summary is machine-generated.

For complex anal fistulas, several surgical techniques show similar failure rates to the advancement flap. However, plugs, fibrin glue, and PRP therapy are linked to higher failure, while the cutting seton technique increases incontinence risk.

Keywords:
Anal incontinenceComplex anal fistulaNetwork meta-analysisPersistenceRecurrenceSurgical treatment

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Area of Science:

  • Colorectal Surgery
  • Gastroenterology
  • Surgical Innovation

Background:

  • Complex cryptoglandular perianal fistulas lack a gold standard surgical treatment.
  • Evaluating and comparing various surgical techniques is crucial for optimal patient outcomes.

Purpose of the Study:

  • To conduct a network meta-analysis comparing postoperative failure and anal incontinence rates for surgical techniques managing complex cryptoglandular anal fistulas.

Main Methods:

  • Systematic literature searches were performed across major databases up to June 2023.
  • Included 16 randomized comparative trials of nine surgical techniques.
  • Utilized PRISMA-NMA methodology with endorectal advancement flap as the control.

Main Results:

  • Techniques like cutting seton, fistulotomy with sphincter reconstruction, LIFT, and VAAFT showed comparable failure rates to the advancement flap.
  • PLUG, fibrin glue, and platelet-rich plasma (PRP) demonstrated significantly higher pooled failure rates.
  • The cutting seton technique was associated with an increased risk of postoperative anal incontinence.

Conclusions:

  • Effective therapeutic strategies exist, emphasizing personalized treatment based on fistula characteristics and patient factors.
  • Recommends against using plugs, fibrin glue, and PRP due to lower healing rates.
  • Advises caution with the cutting seton technique due to potential impact on anal continence.